Empowering parents requires giving them information in a way that they can understand. It is too easy to assume that they understand what we mean.
Give them as much information as possible. Half information can lead to confusion and more fear. Tell them you are giving them this information to empower them. If there are questions for example about a specific condition, tell them what positive things can be done if this is detected.
There is no skating around telling women that things don’t always go to plan after the 12 week period. It’s so important that women have an awareness that things can go wrong later in pregnancy. Not having this knowledge will result in no action being taken if they feel something is wrong. No-one wants to feel they are being a nuisance.
Remember and assure that the information you are giving them does not make it more likely to happen to them. In fact the opposite is true. You are empowering them by letting them know if these symptoms are experienced, your team is there day or night to assess them.
We need to apply basic educational principles – what is the learners start point of understanding, what do they need to know, how can they place the information in the right context?
“Make sure you tell us if you are worried about reduced movements again”.
This doesn’t explain when they should be worried (how to monitor movements), why we want to know, when we want to know, what might come next and doesn’t acknowledge the importance and validity of the maternal experience.
Parents might then think that will just be wasting your time again or that reporting reduced movements again could result in an induction. They may also believe that there’s no urgency so will wait to mention it at their next midwife appointment.
“You were right to come in.”
This supports their decision & validates their concerns.
“Babies can be quiet for a number of reasons, but it can be because they are not well and need urgent help”.
This summarises a range of possibilities but that it may also be serious and urgent.
“We have various ways that we can check what is happening, you can’t work it out for yourself at home”.
This informs parents what we can offer & why coming in for an assessment is right, not to self assess (perhaps via a doppler or Google).
“If it is serious and there is a delay, a baby can die”.
Yes- it’s ok to say it when in the right context! Unless they know the worst case scenario, they won’t understand how important it is.
“If your baby needs help, you are then in the place where we can take action quickly”.
This explains why the hospital would be appropriate.
“Most of the time, when we see people because their baby is quiet, we don’t find a problem with the baby”.
This validates their experience today as a common one. However, this information needs to go hand in hand with:
“But we do need to see you, in case it is the time when we need to act fast to help your baby”.
This reinforces the messages to both report the problem and to be seen as it can become an emergency.
“It makes our day when all’s ok”.
Again, this confirms to parents that you don’t think they are wasting your time and that sometimes, it’s not ok and action needs to be taken.
“Once baby is born, if you think your baby might be unwell you’ll ask for professional advice and you are right to do that now too. A baby you can’t see is very hard to assess, so let us help”.
Validate their role as a parent/protector and offer professional support.
It is also important for parents to know exactly who they should ring and where they should go if they ever have any concerns, especially out of hours.
Expressions that can cause misunderstanding:
“There’s variability on the trace”.
Parents may think that it’s ok some of the time.
“How sure are you that there are no movements?”
This suggests that the parents should have waited until they were positive.
“So you came in yesterday and all was fine?”
Parents will feel dis-empowered to call again.
SBAR Communication Tool:
SBAR is a useful tool which you can use to empower parents.
Situation – Mum is at home and is worried about her baby’s movements.
Background – She’s 36 weeks in her first pregnancy, no problems in the pregnancy, have been feeling baby move frequently until today.
Assessment – She feels well in herself. She knows that baby was moving when she had breakfast, but hasn’t noticed any movement since then and it is now lunchtime. This is unusual for him.
Recommendation – To come in to the hospital now to assess if the baby is just having a quiet time or if he/she is quiet because they are unwell. Relay the need to see them as soon as possible. Inform them that baby may start moving but still to come in because it is right to be checked as it has been unusual.
After assessment, no issues were identified. Communicate SBAR to mum:
Situation – we have assessed baby and you.
Background – you had noticed a change in his movement pattern. You did the correct thing by coming in for an assessment.
Assessment – we haven’t identified anything of concern. Baby has started moving well since you have been here. We have monitored his heartbeat and talked about how we have concluded that the pattern looks normal. Your blood pressure, temperature, pulse and urine are normal and you are feeling well.
Recommendation – continue to be aware of baby’s movements and, as you did this morning, contact us straight away if you have concerns. It was lovely to be able to reassure you today, but we can’t know what will happen in the future. It doesn’t mean that baby can’t have a problem later today or on another day.
Every Encounter Counts:
- It’s ok to discuss complications with women in context
- Talk about chances of problems, not risks (more positive)
- Choose clear and concise language
- Ask parents to relay back to check they’ve understood
- Be specific – how will parents know if they are “concerned”
- Need to grasp importance of reporting RFM
- Ensure parents know who to call and where to go
- Make parents feel comfortable in calling for advice
- Informed choice is knowing ALL options (personalised care)
- Correct colleagues giving out of date advice
Safer Pregnancy Messaging:
The Department Of Health’s safer pregnancy messaging should be given to parents at every opportunity. Full information can be found on our Call The Midwife page. We also have leaflets that are available FOC in English and other languages. Here is a brief summary:
- Attend all antenatal appointments & practice good hygiene
- Understand effect smoking and alcohol has
- Understand importance & how to monitor baby movements
- Know to report symptoms such as itching & bleeding and signs of pre-eclampsia
- Healthy eating and flu/ whooping cough vaccines
- Sleep on your side
Choice of language can play a big part when trying to get parents to listen and understand what you are telling them.
Try changing the word “risk” to “chance” which comes across as more positive.
The RCOG situational awareness video.
The SBAR tool for focused communication.
What is informed consent?
“I’ll just do your bloods for all the usual things , ok?”.
This language does not inform parents what they are being screened for and eliminates choice.
“The test estimates whether there is a high or a low chance that your baby might have one of three conditions”.
This gives parents a much better understanding of what they are being screened for.
Which of the following scenarios leads to informed consent (or decline?)
MW: “Your result came back positive”.
Woman thinks: Positive, oh good, but I thought they only phoned if it was bad news?
MW: “So, shall I arrange an amnio for you?”
Woman: “What…? Why….? No, I don’t want extra tests if the first one was good…what’s an amnio anyway?”
MW: “I’ve got bad news, I’m afraid. It looks like your baby has Downs syndrome”.
Woman: “The results state 1 in 150 chance and anyway, my sister has Downs syndrome & she’s great! Why are you “afraid”? And, BTW, the sonographer said the baby looks fine.”.
MW: “I’m phoning about the test you had last week” (meaning the combined test).
Woman: “I haven’t had any tests”.
MW: “When you had the scan…?”
Woman: “I just had the scan and then they took some blood. I didn’t have the test though because the woman who did the scan said baby looked perfect. I wouldn’t have the test anyway because that test makes you have a miscarriage.”
Many women do not recognise that scan + blood sample = OPTIONAL test. Many think they have to have blood taken and do not understand that this is combined test. They think CVS or amnio only are tests. In units where blood is taken after scan, if scan appearance raises no concern, many women do not realise the significance of the blood sample.
Midwife on delivery suite: “I’m just ringing to let you know about a test result that was wrong”.
Screening MW: “Which test was it?”
Delivery suite MW: “The combined test – it said low risk but the baby has obviously got Downs syndrome”.
Screening MW: “What does the result say?”
Delivery suite MW: “1 in 2,000”.
So this baby is the 1 in that statistic. The test isn’t wrong, the understanding of screening is.
One woman to another in waiting room: “You should have that new test. It’s really worth paying £500 because then you know for sure that everything is completely fine. Sometimes they say that they are worried about things on the scans, but I’ve had the test so I know that the baby is all ok.”
“Why didn’t you say that it is only 1% chance? I have been so worried! You said there was 1 in 100 chance, now I know it’s actually only 1%.”
Numbers can be very confusing so spend some time with the parents to make sure they fully understand what the numbers mean.